Building connected healthcare

Dealing with the explosion of devices on enterprise networks thanks to the increasing use of mobile devices, including those brought into the workplace through 'bring your own device' (BYOD) schemes, can be a headache for IT.

Add in the stack of sensors and other gizmos with an IP address that form part of the 'Internet of Things' and a networking headache can rapidly turn into a migraine.

So spare a thought for Barbara MacKenzie, the head of IS operations and infrastructure at Sydney Adventist Hospital (SAH).

Beyond the kinds of connected devices you would expect to find in a sophisticated and heavily virtualized IT environment, she is dealing with an enterprise network that has enough audio-visual equipment, intelligent building systems and biomedical devices hooked up to it to have anyone reaching for an aspirin or two.

SAH — colloquially known at the San (its history can be traced back to the Sydney Sanitarium, which opened in Wahroonga in 1903) — is New South Wales' largest private hospital. It's the largest not-for-profit hospital in the state.

The San formally changed its name Sydney Adventist Hospital in 1973, and the hospital was rebuilt that year. Today the hospital has some 2300 staff, 500 volunteers and 900 medical practitioners.

Every year it delivers health care to 53,000 inpatients and 180,000 outpatients, according to SAH statistics. It has NSW's busiest private hospital emergency department, with 19,000 patients annually.

A large-scale redevelopment process that began in 2011 gave MacKenzie and her team the opportunity to carry out a rip and replace of network infrastructure at the hospital site.

"In a brownfields site, I had an opportunity to do a complete core infrastructure upgrade, all the way down to site-wide fibre infrastructure upgrades and core and wireless network and also telephony, from a digital system to a SIP core," MacKenzie says.

A digital hospital

SAH has been "quietly heading towards the digital age for the last 20 years," MacKenzie says, with widespread use of intelligent building systems and a drive towards electronic medical records (EMR).

"On the building maintenance and control system side, our engineering department started building intelligent building systems 20 years ago based on Siemens products, and as time has gone on they've stuck with that platform — and today all of that sits on my network," MacKenzie says.

"On the EMR side, with the drive to differentiate ourselves, there's a push towards digital. That began in earnest 15 years ago."

When the process started there wasn't a suitable product on the Australian market, particularly for billing. "So we started building our own modules which have now evolved into quite an extensive suite of clinical systems," MacKenzie says.

"Five years ago we began rolling out patient care pathways, which involved the transition from paper to electronic for observations, [delivery room] and nurses' progress notes. We already had a whole range of the other things that — in hospital speak — form the 'Electronic Medical Record Adoption Model'."

The hospital is one system away from achieving stage 6 in EMR adoption, making it one of the most advanced Australian hospitals when it comes to electronic medical records.

When the new SAH network was designed, the decision was made to put the PLC-based building systems on it.

"We agreed that controllers for extra-low-voltage systems would sit on the enterprise network," MacKenzie says.

"I have now got access control, CCTV, car parking — all of what I term the cowboy systems — at least monitored at controller level."

"It's on the enterprise network, and all the alerting and alarming comes through to us," she adds.

"At the moment we've got 300,000 points sitewide — and they are power, temperature, flows, lights. There's over a 1000 controllers and those points are each being polled about 100 times a second."

The Life Safety and nurse call systems are also integrated into the network, although regulatory requirements mean there are also standalone alert and alarming systems.

Virtualization

When it comes to ICT, the hospital is now heavily virtualized on both the server/data centre side and the desktop side, with the hospital a few years ago rolling out zero clients based on VMware Horizon View that offer access to the SanCare e-Pathways application. The application allows staff to add notes to patients' EMRs.

"We decided to use zero clients with VMware. That's translated now to, in the newest building that I've done — a 40-bed ward — we're running 90 per cent zero clients," MacKenzie says.

The zero clients deliver 'follow-me' virtual desktops and have an RFID-based login.

In addition doctors have been encouraged to bring their own devices.

"On top of the fixed computers, anyone is welcome to use a virtual desktop on whatever device they choose," MacKenzie explains.

"We extensively went virtual desktops a number of years ago and we just keep on improving on it. The RFID single sign-on product we're using —Imprivata's OneSign — is very, very suitable for a hospital environment because of the workflow.

"Staff, literally, walk up to a terminal, swipe or tap their proximity card, and their desktop comes to them [in the same state] they left it, in about four seconds."

The RFID login system went live when SAH opened the first ward in its newest building in August last year and "it spread like wildfire".

"We had to give it to everyone because they were demanding it," MacKenzie says.

Prior to the system's deployment, staff members had to manually enter a username and password to get access to their virtual desktops.

On the server side, MacKenzie says SAH is around 80 per cent virtualized, making heavy use of VMware's family of products and EMC storage.

A networked village

SAH's campus is "actually a small village," MacKenzie says. In addition to acute care hospital services it's a teaching hospital, and its 42 hectares have "everything except a pub to support a small town — and we are the service provider."

"Our network goes everywhere: It goes to every single building. It's doing at the very least security, monitoring of fire control, energy use and stuff like that, if not [connecting] actual computers," MacKenzie says.

Because of the extent of the redevelopment, the network rollout was more akin to a greenfields deployment for MacKenzie and her team. The new core network was deployed in 2012.

In 2013 the hospital's $17 million Clinical Education Centre — a joint effort with the federal and state governments, the University of Sydney and Avondale College of Higher Education — came online.

"It's a true multi-tenanted building with a multi-tenanted network," MacKenzie says

SAH, Sydney Uni and Avondale all work out of the 25 or so teaching spaces and access their services across the same network infrastructure.

"What we focussed on was identity management and we're using Avaya's identity management engine and 802.11 authentication," MacKenzie says.

Like the wards, the education centre has zero clients — "If you log in, there's a drop-down box. You can click which one you want to access and if it's Avondale then it drops you across to Avondale's network, Avondale's presentation of services and their own virtual desktop infrastructure. "

"Clinical schools have cropped up all around Sydney in the last few years and in most cases they literally have two computers sitting next to each other, and we just went 'that is not going to happen'," MacKenzie says.

"Again all the students of whatever flavour can use their own device and using a virtual desktop get access to services as well."

"There was a little bit of a break where we settled in the Clinical Education Centre, and then we went through another round of SIP core upgrades," she says.

The $200 million, 550-bed San Redevelopment officially opened in October last year with a maternity unit and birthing suites, 24 operating theatres, and the hospital's new Integrated Cancer Centre.

The operating theatres in the new clinical services building include "a raft of technologies that have integrated straight into IP-based solutions," MacKenzie says.

"We've just replaced all of our IV pumps with smart pumps and they sit on the enterprise wireless network — they hold a pharmacopeia at the pump and, for consistency and safety, they will only deliver a dose within certain parameters.

“For vitals monitoring we have piloted a product by a company called Sotera — it's an armband worn by the patients and that does their vitals, wirelessly.”

"We just VLAN everything at the moment, but once we go that final step to [Avaya Fabric Connect] then we don't even have to do that."

"Our intensive care unit since 2009 has been completely electronic," MacKenzie adds. "Every single machine connected to you while you're a patient there is feeding data straight back into the EMR."

"So biomedical is really the next challenge — how that is managed and the governance around it," she says.

Building partnerships

MacKenzie says networking vendor Avaya is one of the hospital's key IT partners.

Avaya's Virtual Services Platform (VSP) 9000's is used to deliver the core network and wireless for SAH.

"We were running their previous 8600 platform prior to that and [the upgrade] was a little bit of a no-brainer because they make seriously good product and their technical capabilities are market leading," she says.

She says she can get a level of engagement with Avaya that she doesn't believe she could with other networking vendors.

"I take a very long term view that you choose a partner and you trust that they're going to keep up their side of the deal," MacKenzie says.

"So just having the commitment to one platform and then some sort of feeling of confidence that they can deliver the goods — that's what we've done with VMware and with Avaya and neither of those organisations have let us down."

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